08110066 CITY OF CUPERTINO Tr�Ty�g,g�r� ,�' TA ls ( --"� ..�TssTT
BUILDING DIVISION PgbA1YJ11 � 1 �Q ILEi� ,4111*fl�xs
, ..ss,3•'' wx ..FXV. N, , lz
BUILDING ADDRESS: rt Rvn t NO.
10171 SANTA CLARA AVE AAA FURNACE & ATE ngiinorr
OWNER'S NAME: CONDITIONING PERMIT ISSUE DATE
'ONE: SA CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMH - MECH
REPLC WALL HTR 50, 000 BTU O D O O
u0' LICENSED CONTRACTOR'S DECLARATION lob Description
U C 1 hereby affirm Nat 1 am"camcd umler previsions of CMptcr 9(commencing I)
zm with Section 7M)of Division 3 of Ne Businessand Profesudom Code.and my liecoam is
^?h isfull fo¢e at d
y$Z License CI s l Lilnc
c.a
t
F p Dalt Con ^r
qq 7W , MRCHmiLTS DEC IA N
2< 1 understand my plans shall he used u public records
D-Q
,C�; Licensed Pmfeoianal
3OWNER-BUILDER DECLARATION
I 1 may
aPrm that 1 am exempt from the Contractors License Law for the
Coe) following mason.(Section 7031.5.Business and Professions Code:Any city or county
Y$ which requinss a permit to construct.+lice improve,demolish,or tepair soy strumae
prim at its issuance.also requires Ne applicant for such Permit o file a signed su noon
<
that bcislicensed purmantladmprovisions ofdteComeaclor'sUm.Law(Cbaptn9 Sq.FL Floor Area Valuation
gc (commencing with Section]000)af Division 3 o the Business and professions Code)of
y Nat he is exempt timmlrom and the bola for the alleged exemption.Any violat(on of
Section 7031.5 by any applicant fm a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
trot mom than It hundred dollars($500).
❑1,u owner altlie pmpmy,ser my employcn with ng.u the'vsale compensation,
will do Newark ands: he cmnune,uuedmoneyeds rule(Sec.to an,owner of
and Rafessians Code:The Canuazmrs License{sew oma twt apply m u owns of Required Inspections
property who Wildsorimpmvu Nen:on,andwM dmssucM1warkhimulfar Waugh hu
awn emplaycas,provided Nat soh improvements arc oat intended oro@red(or We.IL
however.Ne Milling m improvement la sold within ons year of improve
omm a for Ne awmr-
Wilder will have tM burden of proving Nu k lid not build or improv for Puryose of ,
calm.).
1,u awn.of the property.am exclusively contracting with licensed conuactms as
construct the project(Sec.7044.Business and Professions Code:)The Coolrumrs Li.
come law does not apply to an owner of properly who Milds or imp ow,;thereon,and,
who contracts for such projects with a contractors)licensed possum,to the Convectors
License Law.
❑I am exempt under Sec .B B P C for Nis...
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 barely a1Btm under penalty of perjury one of tax fallowing decloatians:
1 Mw and will maintain a Cerdfinm of Consent m.16Luum for Workers C--P--
don,u provided for by Section 3700 of the Tabor Code,for the perrarmana of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurama,u required by Section
37W of Ne Taber Code.far the perfonnenecaf the work fmwhich this permit u issued. '
My Workers ompewtion Insurance carrier and Policy number sm:
Cartier. , .paltry No.. r �0
CERT@L OF EX -TION FRO VO RS'
/Ifo G�,4,TMPENSA ON INSURANCE
(Ibis section need trot Mcmnplemd Irma permit is foranc hundred dollars(SIM)
or less)
I certify that in the performance of the work for which this Permit la issued.I Nall not
employ any person in any manocr so az to become subject in Ne Worked Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,ager making this Comfits¢of Exemption.In should
b.ome subject to the Workers Compcnsedan provisions of Ne labor Code,you must
,J O foMwiN comply with such provisions or this permit shall be deemed revoked.
„z„ CONSTRUCTION LENDING AGENCY
Ihereby still.thm ft.is a commuctinn lending agency for Ne performance of
rl ti Ne work fur which this permit is issued(S..309'1,Civ,C.)
Ifo Q Landers Name
,J z T<ndert Address
U Q I certify Nat 1 have rad this application and state deal the aMve information is
iy H coven.)agree to comply with all city and caumy ordinances and sum Ian muting to
-0 building construction.rood hereby aulhonte mposantaties of Nu city to enter upon the
LI) above-menuuad tion pur
property far inspection
G (We)agree to uvt.indemnity and kap harmless the City of Cupertino against
iFy rA liabilitim,judgmenas.cosn and eapcmu which may in any nyaccom against said City
u in consequence of Ne granting of this permit.
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /� _W'/g7
SOU CEREGULA39NS.
/1a_/ //Gs -w i/—/� U� Re-roofs
goutier ofApplrc HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant or future Wilding acupxntsmrc or handle hosNous material
as defined by tM Cupertino Municipal Code.Chapter 9.13.and the Health and Safely
Cade,section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
[IYmNo
Will the applicant or fu bre Wilding accupanl tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Will me ap'litan,or I
it suhavaNnus air contaminants as defined by the Bay Area Air Quality Maogemont all new materials for inspection.
its?
❑Yo /)mS�No
1havemalthehoar o mmdr smquim=nuundcrChapmr6.95ofNeCalifor-
nu Ncalrh&SafclyCode,Sauom]550.5.25533 and]5534.1 undcrsund thuif the Wilding
dues not currently have a tenant.Nu it is my responsibility to notify the occupant of the
mqu' menu which must M met poor to issuance or a Ccnifuam of acupmry' Signature of Applicant Date
vomer or soman<d assent oat All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot : 'I�
APN . . . . . . . . : 32624047 .
DATE ISSUED. . . . . . . : 11/18/2008
RECEIPT # . . . . . . . . . : BS000006641
REFERENCE ID # . . . : 08110066
SITE ADDRESS . . . . . : 10171 SANTA CLARA AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. BOOTH ROBERT K AND RANA M
ADDRESS . . . . . . . . . . : 10173 SANTA CLARA
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1214
RECEIVED FROM . . . . : JIM RANDO
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 293-4717
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------- ---------- - --- ---------- ---------- ----------
1BSEISMICR VALUATION 2 , 075 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
IMRRAA UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---- ---------- ----------
TOTAL PERMIT 224 . 85 0 . 00 224 . 85 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------ --------- --------------
CREDIT CARD 449.70 VISA
---------------
TOTAL RECEIPT 449. 70 .
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -------------------- --
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
oy// v o
CITY OF CUPERTINO
FURNACE/AC
•CUPEkTiNO PERMIT APPLICATION FORM
APN # � n , !O —1, G� Date:
Bbilding Address:
Owner's N e: Phone #:
o O
Contractor: / Phone #;�� g3 tl71J
IJo Wsvjy fY/mit? Fax #:
Contractor License #: Cupertino Business License#:
Contact: Phone #: 5/oF 9S- Y 7/,
L/"X/: /yp<v Z E,e. Fax #:
Building Permit Info:
Elect E' Plumb 2---/ Mech UZ
Residential Commercial
Job Description:
e c e- /&,2 IZ hle47 iC5 0 000 1J'7 -J
For Residlential Installations:
Attic ❑ I" floor �f 2nd floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
,Ze9Sl420
Strapped 7 On Platform El Bonded New Location Replacement
Project Size: Ex ress ❑`/Standard ❑ Laz e ❑ Ma or ❑
Valuation:
am
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 6/16/08
CITY OF CUPERTINO
4
? FURNACE/AC
CUPEkTiNO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system incl
installation of controls regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl in an appliance
pen-nit.
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
/ cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1 MRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install & not incl in an appl permit.
Quantity Fee ID Fee Description Fee Permit Type